Role of a clinical pharmacologist in the treatment of chronic heart failure

Urgency. The gap between evidence-based potentialities of drug therapy in patients with CHF and actual quality of their medical care in the conditions of a real healthcare system is obvious. Ongoing efforts are focused on new approaches to reducing this gap. One of such approaches is the active participation of clinical pharmacologists in the process of treatment; efficacy of this approach is currently intensively studied. Aim. To study the role of a clinical pharmacologist in current management of patients with III-IV NYHA FC CHF. Materials and methods. Study enrolled 100 patients with pronounced III-IV FC CHF of different etiology. Patients were educated on pharmacological methods of treatment during hospitalization; therapeutic regimen was determined before discharge; safety and efficacy were followed up during the outpatient period. Patients were evaluated by common clinical methods including physical examination, ECG, echoCG and X-ray. The following methods were used: subjective evaluation by the physician; the Duke Activity Status Index (DASI); 6 min walking test; and quality of life (QOL). Results. It was shown that the proportion of patients adherent to physicians’ recommendations on the non-drug treatment providing control of CHF symptoms at home considerably increased due to the education in the intervention group. At the same time the proportion of patients adherent to the non-drug treatment remained low after 6 months, although the number of such patients increased in the control group. Economic evaluation of the outcome in the group of multitype intervention performed in our study showed a high cost effectiveness of the intervention. Therefore participation of a clinical pharmacologist in the management of patients with pronounced III-IV FC CHF provides a considerable improvement in the quality of drug therapy. The increased quality of drug treatment in patients with pronounced CHF was associated with significantly reduced need for repeated admission, improved functional condition of patients, and a tendency to improved quality of life.